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Supporting the Continuum of Care for Serious Illness in Medicaid Managed Care October 25, 2021 / by Salom Teshale, Kitty Purington, Wendy Fox-Grage, and Mia Antezzo. Comprehensive care coordination. billion on chronic obstructive pulmonary disease (COPD) per year. Assessment and management of pain and other symptoms.
Coupled with the Centers for Medicare & Medicaid Services’ (CMS) increased focus on seamless caretransitions, Medicare Advantage plans are under pressure to intervene quickly and effectively to prevent avoidable readmissions. billion annually.
rebalancing spending to improve access to home and community-based services, improving caretransitions, or encouraging greater care coordination) Innovative oversight approaches for Medicare/Medicaid integrated models What’s In It for States?
The Centers for Medicare & Medicaid Services (CMS) recently announced two major updates to Medicaid regulations. This blog will delve into their significance and key policy implications for states and managed care organizations (MCO). Ensure Payment Adequacy for HCBS Direct Care Workers.
States are increasingly turning to capitated Medicaid managed care programs to deliver long-term services and supports (LTSS) to individuals with complex needs. California does cover skilled nursing facility care in its MLTSS program, but most personal care services (in-home supportive services) are provided under FFS.
The aim of the partnership was to enhance caretransitions. One takeaway for home health providers is the importance of working with SNFs to further strengthen SNF-to-home transitions. Centers for Medicare & Medicaid Services (CMS). Centers for Medicare & Medicaid Services (CMS).
How State Medicaid Programs Serve Children and Youth in Foster Care May 17, 2022 / Veronnica Thompson. Children and youth in foster care (CYFC) often benefit from targeted services and supports. Yet, many receive fragmented or limited access to care, contributing to higher rates of unmet health needs. [1]
Patient transitions from the hospital to post-acute care providers, including home health agencies, continue to be plagued by incomplete medical records and missing information. Gaps in post-acute caretransitions are so common, in fact, that the U.S.
More states are contracting with managed care organizations (MCO) to provide Medicaid long-term services and supports (LTSS). How do we know if MCOs are delivering equitable, high-quality care to people receiving LTSS? CareTransitions: Individuals receiving LTSS experience smooth and safe transitions between care settings.
At-Home Health Care — Sparta Community Hospital’s home health segment — has made successful caretransitions a priority in an effort to lower rehospitalizations and ER visits. Sparta Community Hospital is located in Southern Illinois and is a 25-bed full-service acute care medical facility.
Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. . By December 2021, enrollment in Medicaid and CHIP (Children’s Health Insurance Program) grew to a record high of more than 83 million individuals, primarily due to the continuous coverage requirements of the PHE.
Last year was a record-breaking year for transaction volume and private-duty across the board, when you add both Medicaid and private pay,” he said last week, during a presentation at Home Health Care News’ Home Care Conference. It was known for Medicaid expansion. Home Health Care News’ Home Care Conference.
The initiative has integrated CHWs into care management teams, where they work alongside certified providers to support caretransitions for high-risk clients, particularly those with dual special needs. Subsequent CHW cohorts have received certification with YMCA grant funding.
The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs ACO Accountable Care Organizations. MCO Managed Care Organizations. MCE Managed Care Entities. MHP Medicaid Health Plans.
CHWs are key to engagement, care coordination, and increasing access to clinical and support services for Medicaid enrollees from their communities. As such, states increasingly are pursuing Medicaid reimbursement options as part of a comprehensive CHW service financing approach, which is currently reliant on expiring grant programs.
On October 20, 2021, the Centers for Medicare and Medicaid (“ CMS ”) Innovation Center (“ Innovation Center ”) published a white paper detailing its vision for the next ten years: a health system that achieves equitable outcomes through high quality, affordable, person-centered care. Strategic Objective 2: Advance Health Equity.
The federal government has boldly detailed nearly 350 actions that agencies overseeing Medicare and Medicaid, Veterans Affairs, housing, labor, and more will take over the next three years to support caregivers. Hartford Foundation.
To identify emerging state aging policy priorities, NASHP — with support from the West Health Policy Center — conducted a series of key informant interviews with a wide range of state officials, including health and human services secretaries/commissioners, Medicaid directors, aging and disability directors, and legislators.
Patrick Blair, formerly of Bayada Home Health Care, has been named president and CEO by InnovAge’s board of directors. The appointment comes after reports that Colorado’s Department of Health Care Policy and Financing and the U.S. Centers for Medicare and Medicaid Services (CMS) stopped reimbursing InnovAge for new clients.
Code § 1396n and apply for § 1115 waivers identified as supportive of substance use prevention or treatment and caretransitions for incarcerated persons.
In September, the Centers for Medicare and Medicaid Services (CMS) announced a new funding opportunity of $106.5 million in planning grants to support states in promoting continuity of care for people transitioning from incarceration to community. This project is a partnership between NASHP and The Health Reentry Project (HARP).
The shift to value-based care. Connecting training with outcomes serves patients and staff, but the shift to value-based care means attention to outcomes is imperative as home-based caretransitions to rewarding providers for the quality of the care they deliver.
ACHC initially focused on accrediting home health agencies, but over the years, it has expanded its scope to include other health care sectors such as hospice, hospital, pharmacy, DME, home care and renal dialysis.
Interest in expanding MOUD access in carceral settings and strengthening reentry supports have been bolstered by new federal flexibilities through state Medicaid 1115 demonstrations that allow Medicaid reimbursement for certain services provided to individuals during the 90 days before they are released from incarceration (see text box below).
For example, Washington’s family caregiver support program within its Medicaid 1115 waiver was built upon data from a state-only program for unpaid caregivers of adults with movement or cognitive limitations. The state evaluated the impact of expanding its family caregiver support program in 2012.
The company’s comprehensive patient data will now enable Oak Street Health to simplify care collaboration, initiate timely care interventions post-discharge, and achieve value-based care goals in line with the Centers for Medicare and Medicaid Services Star Rating Program and Direct Contracting Model. “To
As states are seeking sustainable financing models and partnerships that offer continued support for the CHW services beyond the COVID-19 pandemic, many are exploring Medicaid reimbursement models. APMs can apply to a specific clinical condition, a care episode, or a population.” What is an Alternative Payment Model?
Effective communication during caretransitions, along with proper medication reconciliation, is vital for preventing readmissions and improving overall patient outcomes. This program underscores the importance of improving caretransitions to minimize patient readmissions within a 30-day timeframe post-discharge.
The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.
Medicaid Reimbursement. Medicaid Reimbursement. Alabama does not reimburse for CHW services through its Medicaid program. Alaska Medicaid reimburses for CHW services through MCOs as authorized under the state plan. Arizona does not currently reimburse for CHW services through its Medicaid program.
Value-based care, a model that rewards better patient health outcomes, has experienced a surge in interest amid heightened consumer awareness and among payers seeking to lower costs and stabilize reimbursement. The acceleration of the value-based caretransition isn’t slowing; the good news is, it’s not too late to get started.
The National Care Coordination Standards for CYSHCN, released by the National Academy for State Health Policy in October 2020, describe the importance of focusing care coordination quality measurement for pediatric populations on the extent to which patients’ and families’ goals and needs are met and burdens reduced. [8] Score – 12).
Nearly every state that reviews pregnancy-related deaths has recommendations focusing on: Ensuring adequate insurance coverage and payment, Increasing early identification and referrals, Ensuring referrals and follow-up care, and/or. Expand Medicaid coverage for postpartum women. Increasing access to specific services.
Shared Plan of Care. Care Coordination Workforce. CareTransitions. public health, Medicaid, mental health) and other stakeholders (e.g., On the other hand, a health plan may use the guide to implement a high-quality screening and assessment process through primary care providers. State Medicaid agencies.
Approaches include allowing family caregivers to receive Medicaid reimbursement , providing culturally competent trainings and peer supports, making respite care more accessible for caregivers, and offering behavioral health supports for caregivers. skilled nursing, home health care, behavioral health, etc.)
Hospitals and health systems face mounting pressure to reduce unnecessary readmissions, particularly the Hospital Readmissions Reduction Program – a Centers for Medicare & Medicaid Services (CMS) value-based initiative – which penalizes hospitals with relatively higher rates of Medicare readmissions.
The State Plan also identified several evidence-based strategies to meet the benchmark established to improve home care workforce capacity and caregiving supports, including providing respite care, financial supports and investments in the direct care workforce, and caregiver support for those who have Alzheimer’s disease and dementia.
As the federal government prepares to transition to a new administration, states are entering their legislative sessions, with some navigating Medicaid budget shortfalls and awaiting next steps at the federal level. States have pursued these waivers with the goal of reducing health care costs while improving access to health care.
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